IMPROVING PERIOPERATIVE NUTRITION Preoperative – Since protein requirements are increased by the surgical stress response, current recommendations are that patients should receive at least 1.2-2.0 grams of protein/kilogram of body weight/day. [9] Studies show that 25-30 grams of protein in a single meal results in the most protein synthesis and is optimal when repeated multiple times per day. [11] Patients who are screened at risk for poor nutritional status should receive a high-protein oral nutritional supplement containing at least 18 grams protein/dose, 2-3 times/day for a minimum of 7-14 days. In addition, in many (but not all) patients and in order to minimize the detrimental effects of fasting, clear fluids can be taken up to 2 hours prior to anesthesia. Similarly, at least 45 grams of a carbohydrate drink as a clear liquid taken 2-3 hours before surgery may, in many surgeries, improves insulin sensitivity (typically decreased by the surgical stress response) and results in better blood sugar control. The addition of specific nutritional elements such as vitamin D, hydroxymethylbutyrate, zinc, and bromelain, that can reduce postoperative muscle breakdown, support immune function, optimize gut function, and reduce pain and swelling should also be considered. Postoperative – For most surgeries, early resumption of oral intake is recommended as tolerated. Once again, protein supplementation is needed during the recovery period to maintain lean muscle mass. This can be accomplished using a high-protein diet (1.5-2.0 grams/kilogram of body weight/day) or oral nutritional supplements. Nutritional supplementation, which again include elements like vitamin D, hydroxymethylbutyrate, zinc, and bromelain should continue for a minimum of 4-8 weeks after surgery and possibly up to 3-6 months after surgery in those who are severely malnourished. It is important to remember that the protein intake goal is more important than total calorie intake during this period of healing and recovery.
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